Treatment of Facial Pain by Percutaneous Differential Thermal Trigeminal Rhizotomy

BackgroundTrigeminal neuralgia (TN) has the highest incidence of disorders causing facial pain. TN is provoked by benign stimuli, like shaving, leading to severe, short-lasting pain. Patients are initially treated using antiepileptic drugs; however, multiple invasive options are available when conservative treatment proves insufficient. Percutaneous radiofrequency treatment of the trigeminal, or gasserian, ganglion (RF-G) is a procedure regularly used in refractory patients with comorbidities. RF-G involves complex needle maneuvering to perform selective radiofrequency heat treatment of the affected divisions. We present a unique case of cranial nerve 4 (CN4) paralysis after RF-G.Case presentationA male patient in his 60s presented with sharp left-sided facial pain and was diagnosed with TN, attributed to the maxillary and mandibular divisions. MRI showed a vascular loop of the anterior inferior cerebellar artery without interference of the trigeminal complex. The patient opted for RF-G after inadequate conservative therapy. The procedure was performed by an experienced pain physician and guided by live fluoroscopy. The patient was discharged without problems but examined the following day for double vision. Postprocedural MRI showed enhanced signaling between the trigeminal complex and the brainstem. Palsy of CN4 was identified by a neurologist, and spontaneous recovery followed 5 months after the procedure.ConclusionsMention of postprocedural diplopia in guidelines is brief, and the exact incidence remains unknown. Different mechanisms for cranial nerve (CN) palsy have been postulated: incorrect technique, anatomical variations, and secondary heat injury. We observed postprocedural hemorrhage and hypothesized that bleeding might be a contributing factor in injury of CNs after RF-G.

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Item Response Theory for Psychometric Properties of the SNOT-22 (22-Item Sinonasal Outcome Test)

Otolaryngology ◽

10.1177/01945998211018383 ◽

2021 ◽

pp. 019459982110183

Author(s):

David T. Liu ◽

Katie M. Philips ◽

Marlene M. Speth ◽

Gerold Besser ◽

Christian A. Mueller ◽

...

Keyword(s):

Item Response Theory ◽

Psychometric Properties ◽

Item Response ◽

Chronic Rhinosinusitis ◽

Facial Pain ◽

Item Discrimination ◽

High Quality ◽

Graded Response ◽

Sinonasal Outcome Test ◽

Snot 22

Objective The SNOT-22 (22-item Sinonasal Outcome Test) is a high-quality outcome measure that assesses chronic rhinosinusitis–specific quality of life. The aim of this study was to gain greater insight into the information provided by the SNOT-22 by determining its item-based psychometric properties. Study Design Retrospective cohort study. Setting Tertiary care academic centers. Methods This study used a previously described data set of the SNOT-22 completed by 800 patients with chronic rhinosinusitis. Item response theory graded response models were used to determine parameters reflecting item discrimination, difficulty, and information provided by each item toward the SNOT-22 subdomain to which it belonged. Results The unconstrained graded response model fitted the SNOT-22 data best. Item discrimination parameters and total information provided showed the greatest variability within the nasal subdomain, and the item related to sense of smell/taste demonstrated the lowest discrimination and provided the least amount of information overall. The dizziness item provided disparately lower total information and discrimination in the otologic/facial pain subdomain. Items in the sleep and emotional subdomains generally provided high discrimination. While items in the nasal, sleep, and otologic/facial pain subdomains spanned all levels of difficulty, emotional subdomain items covered higher levels of difficulty, indicating greater information provided at higher levels of disease severity. Conclusion The item-specific psychometric properties of the SNOT-22 support it as a high-quality instrument. Our results suggest the need and possibility for revision of the smell/taste dysfunction item, for example its wording, to improve its ability to discriminate among the different levels of disease burden.

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A novel method to treat recurrent facial pain: a case report

Journal of Medical Case Reports ◽

10.1186/s13256-021-02888-1 ◽

2021 ◽

Vol 15 (1) ◽

Author(s):

Jintakorn Kuvatanasuchati ◽

Karoon Leowsrisook

Keyword(s):

Case Report ◽

Trigeminal Neuralgia ◽

Facial Pain ◽

Case Presentation ◽

Facial Movements ◽

Novel Treatment ◽

Effective Cost ◽

Novel Method

Abstract Background Chronic facial pain is a serious condition affecting millions of people worldwide. The reasons for chronic facial pain vary, and currently, the methods of treating chronic facial pain are expensive, invasive, and, based on current findings, ineffective. The purpose of this study is to develop and test an effective, cost-friendly method to treat patients with chronic facial pain. This study will examine the effectiveness of a novel treatment of a patient suffering from trigeminal neuralgia. Case presentation A 70-year-old Thai female visited the advanced general dentistry clinic at the Faculty of Dentistry, Mahidol University, Bangkok, Thailand. She was suffering from facial pain on her left side and was diagnosed by a physician as having trigeminal neuralgia. She experienced a sharp shooting pain that was triggered by facial movements such as chewing, speaking, or brushing teeth, and touching certain areas of her face. Bouts of pain lasted from a few seconds to several minutes, and episodes of several attacks lasted days, weeks, months, or longer prior to her visit to the advanced general dentistry clinic at Mahidol University. Physician designed an occlusal equilibration appliance for treating the patient by inserting the appliance in the mouth for dental occlusal equilibration (deprogram). The patient used this appliance by placing it in the mouth continuously (day and night) and removed it only when eating. After using the appliance for 2 weeks, the patient appeared to feel and look better prior to taking medication and was able to eat normally. The patient was pain free after treatment for a duration of 9 months. However, after 9 months, the pain reoccurred and manifested itself. Conclusion This novel treatment of recurrent facial pain showed an improvement of the patient’s chronic facial pain and serves as evidence to being a novel method for treating those suffering from trigeminal neuralgia.

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Reference programme: diagnosis and treatment of headache disorders and facial pain. Danish Headache Society, 3rd edition, 2020

The Journal of Headache and Pain ◽

10.1186/s10194-021-01228-4 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Henrik W. Schytz ◽

Faisal M. Amin ◽

Rigmor H. Jensen ◽

Louise Carlsen ◽

Stine Maarbjerg ◽

...

Keyword(s):

Health Care ◽

Health Care Professionals ◽

Primary Care Physicians ◽

Facial Pain ◽

Common Interest ◽

Diagnosis And Treatment ◽

Primary Headaches ◽

Secondary Headache ◽

Great Success ◽

Headache Disorders

AbstractHeadache and facial pain are among the most common, disabling and costly diseases in Europe, which demands for high quality health care on all levels within the health system. The role of the Danish Headache Society is to educate and advocate for the needs of patients with headache and facial pain. Therefore, the Danish Headache Society has launched a third version of the guideline for the diagnosis, organization and treatment of the most common types of headaches and facial pain in Denmark. The second edition was published in Danish in 2010 and has been a great success, but as new knowledge and treatments have emerged it was timely to revise the guideline. The recommendations for the primary headaches and facial pain are largely in accordance with the European guidelines produced by the European Academy of Neurology. The guideline should be used a practical tool for use in daily clinical practice for primary care physicians, neurologists with a common interest in headache, as well as other health-care professionals treating headache patients. The guideline first describes how to examine and diagnose the headache patient and how headache treatment is organized in Denmark. This description is followed by sections on the characteristics, diagnosis and treatment of each of the most common primary and secondary headache disorders and trigeminal neuralgia. The guideline includes many tables to facilitate a quick overview. Finally, the particular challenges regarding migraine and female hormones as well as headache in children are addressed.

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